A spate of online ads for poppers has led a longtime San Francisco activist and city health officials to address the availability of butyl and other alkyl nitrites sold in small bottles that some gay men sniff to produce a high during sex.

"This is a public health problem," said Hank Wilson, who founded the Committee to Monitor Poppers in 1981. Wilson believes poppers use increases susceptibility to HIV infection, and he wants to make sure people - especially the younger generation - are aware of the risks.

"We need public health [officials] and the community to not accept this harm that's being done to our community," Wilson said.

Poppers have long been available in stores, but the Internet has brought easier access to the non-safety tested products.

Under the Consumer Product Safety Act, butyl and other alkyl nitrites can be made, sold, distributed, or imported into the country for any commercial purpose other than for the production of consumer products containing these nitrites "that may be used for inhaling or otherwise introducing [them] into the human body for euphoric or physical effects."

The Consumer Product Safety Commission can pursue recall, or civil or criminal penalties when the rules are violated.

To get around this, poppers are typically marketed as video head cleaner and room odorizer, but they're also advertised openly as poppers.

Wilson wrote in an e-mail that he's made multiple complaints to the safety commission, but there's been no notice if the agency received his complaints, and there's appeared to be no action, he said.

Wilson said there are several ways using poppers can increase susceptibility to contracting HIV. For one thing, he said, users' inhibitions may be lowered, leading to riskier behavior.

Poppers can cause muscles in the anus to relax. According to Dr. Jeffrey Klausner, director of STD Prevention for San Francisco's health department, the anal tissue may be more easily damaged, increased blood flow resulting from using poppers brings in more target cells, and it's been suggested that use may cause at least a temporary reduction of the functioning of the immune system, potentially increasing the chance for HIV infection, among other risks.

Klausner also said combining poppers with drugs like Viagra has the potential to cause stroke and heart attacks.

Internet availability

Wilson said he's worked to get Google, Yahoo, and Microsoft to address the availability of poppers through their sites. The results have been mixed.

Dr. Grant Colfax, the health department's HIV prevention director, sent a message dated January 30 to Google stating that he'd found sponsored links and other Web sites advertising poppers.

Colfax said Google has been responsive when the department asked the company to take the ads down. He said when the ads have gone back up, the company has again been responsive to the health department.

Klausner said that as recently as last week, he'd seen sponsored ads on Google. A search on Wednesday, August 27, for "poppers" resulted in links to sites selling poppers, as well as a sponsored ad appearing to the right of the other search results. The ad was gone later in the day.

Earlier, no sponsored ads had appeared. "If that's gone, that's good," Klausner said at that time. He said the fact that they'd previously appeared after Google had agreed to stop them "suggests they need to do a better job of monitoring and enforcing their own internal policy."

A Google spokeswoman wrote in an e-mail to the Bay Area Reporter when no sponsored ads appeared, "We understand that the use of illegal poppers poses serious health problems, which is why we do not allow ads for the promotion or sale of poppers. We encourage people to report Web sites that may be illegal to appropriate legal authorities. We understand that abuse taking place through the online sale of poppers is a serious issue."

Until at least last Friday, typing "poppers" into the search box on Yahoo had resulted in sponsored ads, but they were gone by Tuesday. Links to sites selling poppers still came up in the search results.

Yahoo spokeswoman Kristen Wareham wrote in an e-mail to the B.A.R., "Yahoo is deeply committed to providing a high-quality experience for our users, advertisers, and publishers. As such, we have rigorous standards and guidelines about acceptable advertising content. After reviewing the 'poppers' marketplace, we are taking appropriate action to enforce our advertising policies in this marketplace."

Links to Web sites selling poppers can also be found on msn.com. In an e-mail to the B.A.R., a Microsoft spokesman wrote, "The results on Live Search are not an endorsement, in any way, of the viewpoints held by the owners of that content. The ranking of our results is done in an automated manner through our algorithm and results are not censored or editorialized. We always work to maintain the integrity of our results."

Risks questioned

A spokeswoman for the Centers for Disease Control and Prevention said the agency has recent research examining the use of individual substances, including poppers. However, she wrote in an e-mail, recent research indicates that methamphetamine is the only substance associated with sexual risk in the last anal sex encounter of men who have sex with men, specifically unprotected receptive anal sex. There are no significant data on insertive anal sex, she said.

She wrote that the information "refers to a baseline sample of very high-risk MSM, who had unprotected anal sex in the past six months and also had anal sex while drunk or high in the past six months."

"While other studies over recent decades have found poppers to be significantly associated with sexual risk among MSM, this has not been consistently shown across studies or across samples of MSM. In other words, some studies find an association and others do not."

Bob Sienkiewicz, who owns the site www.gayhankies.com, which sells poppers and was the sponsored link on Google early Wednesday morning, wrote in response to questions from the B.A.R., "Although the products are not specifically labeled or sold as inhalants, it's clear what people use them for. The link to increased rates [of] HIV infection was widely discussed in the 1980s but never proven - I believe each person has a responsibility to educate himself and make an informed choice about his behavior." Sienkiewicz, who said he sells about 125 to 175 bottles a month, noted he also sells condoms and lubes on his site, and he's added a "Poppers and Your Health" page.

Colfax maintains that there's "very compelling" data that poppers use is linked to an increase in high-risk behavior.

Education

Poppers have traditionally been found in bookstores and head shops, where point-of-sale signs warning of possible health risks are supposed to be posted.

Klausner said the consistency of enforcement has been inadequate, because it's unclear who's responsible for doing the enforcement.

"In the past, the health department has made visits, and those visits had resulted in improved adherence," Klausner said. "It's possible those type of visits could be restarted again, but it's an issue of priorities." With limited resources, the health department has to consider what's the highest impact activity it can do to reduce the spread of HIV and STDs, Klausner said.

Wilson, who is living with AIDS, said he started researching poppers in 1981 when the epidemic was noticed.

"My sexbuddy always used poppers during sex and poppers were suspected of causing the mysterious health conditions," Wilson wrote in an e-mail. "I stopped using poppers after my first trip to the medical library in 1981."

Colfax said comprehensive strategies need to be developed that address substance use and HIV transmission including among polysubstance users. He said data indicate almost no gay men are using poppers exclusively, and men in a number of focus groups haven't thought of poppers as a serious drug, highlighting the challenges in addressing poppers use.

Colfax said as the city's HIV Prevention Planning Council moves forward with developing the latest prevention plan, there will be many conversations about substance use in general, and he expects poppers will be an integral part of that.

He said training's being done at San Francisco City Clinic around poppers and HIV risk, and information about poppers and HIV risk has been disseminated to the health department's funded prevention providers.

For more information, visit http://sfhiv.org/. The Consumer Product Safety Commission's Web site is http://www.cpsc.gov. The number for the agency's consumer hotline is (800) 638-2772. To read the portions of the Consumer Product Safety Act that apply to butyl and alkyl nitrites, visit http://www.cpsc.gov/businfo/cpsatext.html#sec8 . Hank Wilson's Web site is http://poppers.cfsites.org .